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General NPI Number Information
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NPI Number | 1447267000
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Entity Type | Individual
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Provider Name | KRAIYUTH VONGXAIBURANA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 4343 WEST NEWBERRY RD
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City | GAINESVILLE
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State | FL
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Zip | 32607-2817
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Country | US
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Telephone | 352-224-2200
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Fax | 352-224-2484
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Provider Business Mailing Address
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Address Line | 4881 NW 8TH AVE SUITE 2
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City | GAINESVILLE
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State | FL
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Zip | 32605-4582
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Country | US
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Telephone | 352-373-6338
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Fax | 352-373-6144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME92316
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | ME92316
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License Number State | FL
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